Table 1 Key components and comparison between existing and proposed model

Governance and service structure

RMMR & QUM activities are conducted by independent pharmacist (who are contractors) on visitational basis.

Pharmacist is employed by the RACF and is incorporated into RACFs care team.

Pharmacist works within RACFs clinical governance structures.

Multi-disciplinary care (including resident and family)

Pharmacist is not incorporated into the RACF care team. They visit RACF at semi-regular intervals, provide medication advice to GPs through RMMRs and provide quality improvement projects.

Pharmacist is incorporated into the RACF care team and has contact with residents, families, GPs and prescribers, nurses and care staff. The pharmacist is available on-site at RACFs and involves residents and families into decision-making processes to improve medication management.

Reciprocal interdependence

Pharmacist provides medication review as an add-on service to assist GPs with quality of prescribing. However, they are not incorporated into the RACF care teams.

Multi-disciplinary team members, including pharmacists, nurses, carers, GPs and prescribers, community pharmacists, residents and families engage in shared decision making and work together to achieve goals.

Communication

Pharmacist communicates medication-related issues about individual residents to the GPs, usually through RMMR. GPs communicate medication changes to RACF nurses.

Pharmacist communicates and coordinates medication-related issues directly with GPs, nurses, carers, residents, community pharmacy and hospital.

Collaboration

Pharmacist usually collaborates with GPs to conduct RMMR.

Pharmacist closely collaborates on a regular basis with nurses, aged care staff and management, GPs and other prescribers, visiting pharmacists, community pharmacy, residents, families and hospital.

Sharing and access to information

Pharmacist has limited access to residents’ clinical records, which may include laboratory reports, while GPs and nurses have full access to clinical records.

All team members, including the pharmacist, will have full access to residents’ records, current medication lists, information about allergies, lab results, notes, procedures, and hospital discharge summaries.

Coordinated care/outcomes

Pharmacist provides once-off advice and opinion to GPs in RMMRs (including 2 follow-ups) but are not involved in implementing medication management changes or ongoing monitoring.

Residents’ treatment goals and outcomes are coordinated within the team of nurses, carers, pharmacist, GPs and other service providers. Pharmacist is involved in providing advice to GPs, prescribers and the RACF care team, and in implementing residents care plans and goals of care. Pharmacist also contributes to improving RACF medication management policies and procedures.